脉濡而弱，弱反在关，濡反在巅；微反在上，涩反在下。微则阳气不足，涩则无血。阳气反微，中风、汗
出而反躁烦；涩则无血，厥而且寒。阳微（赵本有“则”字）不可下，下之则心下痞硬。
阳微下之，阳气已虚，阴气内甚，故心下痞硬。
动气在右，不可下。下之则津液内竭，咽燥、鼻干、头眩、心悸也。
动气在右，肺之动也。下之伤胃动肺，津液内竭。咽燥鼻干者，肺属金主燥也；头眩心悸者，肺主气而虚也。
动气在左，不可下。下之则腹内拘急，食不下，动气更剧。虽有身热，卧则欲蜷。
动气在左，肝之动也。下之损脾而肝气益胜，复行于脾，故腹内拘急，食不下，动气更剧也。虽有身热，
以里气不足，故卧则欲蜷。
动气在上，不可下。下之则掌握热烦，身上浮冷，热汗自泄，欲得水自灌。
动气在上，心之动也。下之则伤胃，内动心气。心为火主热，《针经》曰∶心所生病者，掌中热。肝为
脏中之阴，病则虽有身热，卧则欲蜷，作表热里寒也；心为脏中之阳，病则身上浮
冷，热汗自泄，欲得水自灌，作表寒里热也。二脏阴阳寒热，
明可见焉。
动气在下，不可下。下之则腹胀满，卒起头眩，食则下清谷，心下痞也。
动气在下，肾之动也。下之则伤脾，肾气则动，肾寒乘脾，故有腹满、头眩、下清谷、心下痞之证也。
咽中闭塞，不可下。下之则上轻下重，水浆不下，卧则欲蜷，身急痛，下利日数十行。
咽中闭塞，胃已不和也。下之则闭塞之邪为上轻，复伤胃气为下重，至水浆不下，卧则欲蜷，身急痛，
下利日数十行，知虚寒也。
诸外实者，不可下。下之则发微热，亡脉厥者，当脐（赵本作“齐”）握热。
外实者，表热也，汗之则愈，下之为逆。下后里虚，表热内陷，故发微热。厥深者，热亦深，亡
脉厥者，则阳气深陷，客于下焦，故当脐握热。
诸虚者，不可下。下之则大渴，求水者易愈；恶水者剧。
《金匮玉函》曰∶虚者十补，勿一泻之。虚家下之为重虚，内竭津液，故令大渴。求水者，阳气未竭，而
犹可愈；恶水者，阳气已竭，则难可制。
脉濡而弱，弱反在关，濡反在巅；弦反在上，微反在下。弦为阳运，微为阴寒。上实下虚，意欲得温。
微弦为虚，虚者不可下也。
虚家下之是为重虚。《难经》曰∶实实虚虚，损不足益有余。此者，是中工所害也。
微则为咳，咳则吐涎，下之则咳止，而利因不休，
利不休，则胸中如虫啮，粥入则出，小便不利，两胁拘急，喘息为难，颈背相引，臂则不仁，极寒反汗出，身冷
若冰，眼睛不慧，语言不休，而谷气多入，此为除中，口虽欲言，舌不得前。
《内经》曰∶感于寒，则受病。微则为咳，甚则为泄、为痛。肺感微寒为咳，则脉亦微也。下之，气下咳虽
止，而因利不休，利不休则夺正气，而成危恶。胸中如虫啮，粥入则出，小便不利，两胁拘急，喘息为难者，里
气损也。颈背相引，臂为不仁，极寒反汗出，身冷如冰者，表气损也。表里损极，至阴阳俱脱，
眼睛不慧，语言不休。《难经》曰∶脱阳者见鬼，脱阴者目盲。阴阳脱者，应不能食，而谷多入者，此
为除中，是胃气除去也，口虽欲言，舌不得前，气已衰脱，不能运也。
脉濡而弱，弱反在关，濡反在巅；浮反在上，数反在下。浮为阳虚，数为无（医统本作“亡”）血，浮
为虚，数为（赵本作“生”）热。浮为虚，自汗出而恶寒；数为痛，振寒而（赵本作“而寒”）栗。微弱
在关，胸下为急，喘汗而不得呼吸，呼吸之中，痛在于胁，振寒相搏，形如疟状，医反下之，故令脉数、发热、
狂走见鬼，心下为痞，小便淋沥，（赵本作“漓”）小（赵本作“少”）腹甚硬，小便则尿血也。
弱在关，则阴气内弱；濡在巅，则阳气外弱。浮为虚，浮在上，则卫不足也，故云阳虚。阳虚不固，故腠
理汗出、恶寒；数亦为虚，数在下则荣不及，故云亡血。亡血则不能温润腑脏，脉数而痛，振而寒栗。微弱
在关，邪气传里也，里虚遇邪，胸下为急，喘而汗出，胁下引痛，振寒如疟。此里邪未实，表邪未
解，医反下之，里气益虚，邪热内陷，故脉数、发热、狂走见鬼，心下为痞，此热陷于中焦者也。若热
气深陷，则客于下焦，使
小便淋沥，小腹甚硬，小便尿血也。
脉濡而紧，濡则胃（赵本医统本并作“卫”）气微，紧则荣中寒。阳微卫中风，发热而恶寒；荣紧
胃气冷，微呕心内烦。医为（赵本作“谓”）有大热，解肌而发汗。亡阳虚烦躁，
心下苦痞坚。表里俱虚竭，卒起而头眩。客热在皮肤，怅怏不得眠。不知胃气冷，紧寒在关元。技巧无所施，
汲水灌其身。客热应时罢，栗栗而振寒。重被而覆之，汗出而冒巅。体惕而又振，小便为微难。寒气因水发，
清谷不容间。呕变反肠出，颠倒不得安。手足为微逆，身冷而内烦。迟欲从后救，安可复追还。
胃冷荣寒，阳微中风，发热恶寒，微呕心烦。医不温胃，反为有热，解肌发汗，则表虚亡阳，烦躁，心
下痞坚。先里不足，发汗又虚其表，表里俱虚竭，卒起头眩。客热在表，怅怏不得眠。医不救里，但责表热，
汲水灌洗以却热，客热易罢，里寒益增，栗而振寒。复以重被覆之，表虚遂汗出，愈使阳气虚也。
巅，顶也。颠冒而体振寒，（医统本作“顶冒颠体振寒”）小便难者，亡阳也。寒因水发，下为清谷，上为
呕吐，外有厥逆，内为躁烦，颠倒不安，虽欲拯救不可得也。《本草》曰∶病势已过，命将难全。
脉浮而大，浮为气实，大为血虚。血虚为无阴，孤阳独下阴部者，小盒饭赤而难，胞中当虚，今反小便
利，而大汗出，法应卫家当微，今反更实，津液四射，荣竭血尽，干烦而不得眠，血薄肉消，而成暴（赵本
注∶“一云黑”）液。医复以毒药攻其胃，此为重虚，客阳去有期，必下如污泥而死。
卫为阳，荣为阴。卫气强实，阴血虚弱，阳乘阴虚，下至阴
部。阴部，下焦也。阳为热则消津液，当小便赤而难；今反小便利而大汗出者，阴气内弱也。经曰∶阴弱者，
汗自出。是以卫家不微而反更实，荣竭血尽，干烦而不眠，血薄则肉消，而成暴液者，津液四射也。医
反下之，又虚其里，是为重虚，孤阳因下而又脱去，气血皆竭，胃气内尽，必下如污泥而死也。
脉数者，久数不止，止则邪结，正气不能复，正气却结于脏，故邪气浮之，与皮毛相得。脉数者，不可
下，下之则（赵本无“则”字）必烦利不止。
数为热，止则邪气结于经络之间，正气不能（医统本作“得”）复行于表，则却结于脏，邪气独浮于
皮毛。下之虚其里，邪热乘虚而入，里虚协热，必烦利不止。
脉浮大，应发汗，医反下之，此为大逆。（赵本有“也”字）
浮大属表，故不可下。病欲吐者，不可下。
呕多，虽有阳明证，不可攻之。
为邪犹在胸中也。
太阳病，（赵本有“有”字）外证未解，不可下，下之为逆。
表未解者，虽有里证亦不可下，当先解外为顺；若反下之，则为逆也。经曰∶本发汗而复下之，
此为逆也。若先发汗，治不为逆。
夫病阳多者热，下之则硬。
阳热证多，则津液少，下之虽除热，复损津液，必便难也。或谓阳多者表热也，下之则心下硬。
无阳阴强，大便硬者，下之则（赵本无“则”字）必清谷腹满。
无阳者，亡津液也；阴强者，寒多也。大便硬则为阴结，下之虚胃，阴寒内甚，必清谷腹满。
伤寒发热，头痛，微汗出。发汗，则不识人；熏之则喘，不得小便，心腹满；下之则短气，小便难，头痛，
背强；加温针则衄。
伤寒则无汗，发热，头痛，微汗出者，寒邪变热，欲传于里也。发汗则亡阳，憎热，故不识人；若以火
熏之，则火热伤气，内消津液，结为里实，故喘，不得小便，心腹满；若反下之，则内虚津液，邪欲入里，外
动经络，故短气，小便难，头痛，背强；若加温针，益阳增热，必动其血而为衄也。
伤寒，脉阴阳俱紧，恶寒发热，则脉欲厥。厥者，脉初来大，渐渐小，更来渐渐大，（赵本下无“渐”
字）是其候也。如此者恶寒，甚者，翕翕汗出，喉中痛；（赵本有“若”字）热多者，目赤脉多，睛不慧，
医复发之，咽中则伤；若复下之，则两目闭，寒多者（赵本无“者”字）便清谷，热多者（赵本
无“者”字）便脓血；若熏之，则身发黄；若熨之，则咽燥。若小便利者，可救之；（赵本有“若”字）
小便难者，为危殆。
脉阴阳俱紧，则清邪中上，浊邪中下，太阳少阴俱感邪也。恶寒者少阴，发热者太阳，脉欲厥者，表
邪欲传里也。恶寒甚者，则变热，翕翕汗出，喉中痛，以少阴之脉循喉咙故也。热多者，太阳多也；目赤脉多
者，睛不慧，以太阳之脉起于目故也。发汗攻阳，则少阴之热因发而上行，故咽中伤。若复下之，则
太阳之邪，因虚而内陷，故两目闭。阴邪下行为寒多，必便清谷；阳邪下行为热多，必便脓血。熏之，则火
热甚，身必发黄。熨之，则火热轻，必为咽燥。小便利者，为津液未竭，犹可救之；小便难者，津液已绝，
则难可制而危殆矣。
伤寒发热，口中勃勃气出，头痛，目黄，衄不可制，贪水者必呕，恶水者厥。若下之，咽中生疮，假令手足
温者，必下重便脓血。头痛目黄者，若下之，则两（赵本无“两”字）目闭。贪水者，（赵本有“若下之其”
四字）脉必厥，其声嘤，咽喉塞；若发汗，则战栗，阴阳俱虚。恶水者，若下之，则里冷不嗜食，大便完谷
出；若发汗，则口中伤，舌上白苔，烦躁，（赵本医统本并作“躁”）脉数实，不大便，六七日
后，必便血；若发汗，则小便自利也。
伤寒发热，寒变热也。口中勃勃气出，热客上膈也。头痛目黄，血（医统本作“衄”）不可制者，热蒸于
上也。《千金》曰∶无阳即厥，无阴即呕。贪水者必呕，则阴虚也；恶水者厥，则阳虚也。发热口中勃勃气
出者，咽中已热也，若下之亡津液，则咽中生疮，热因里虚而下，若热气内结，则手足必厥。设手足温
者，热气不结而下行，作协热利，下重便脓血也。头痛目黄者，下之，热气内伏，则目闭也。贪水为阴虚，
下之又虚其里，阳气内陷，故脉厥声嘤，咽喉闭塞。阴虚发汗，又虚其阳，使阴阳俱虚而战栗也。恶水为阳
虚，下之又虚胃气，虚寒内甚，故里冷不嗜食。阳虚发汗，则上焦虚燥，故口中伤烂，舌上白苔而烦
燥（医统本作“躁”）也。经曰∶脉数不解，合热则消谷喜饥。至六七日不大便者，此有瘀血，此脉数实，
不大便六七日，热蓄血于内也。七日之后，邪热渐解，迫血下行，必便血也。便血发汗，阴阳俱虚，故小便利。
下利，脉大者，虚也，以其（赵本无“其”字）强下之故也。设脉浮革，固尔肠鸣者，属当归四逆汤
主之。（赵本无“主之”二字，有“当归四逆汤方”详见卷六）
脉大为虚，以未应下而下之，利因不休也。浮者，按之不足也；革者，实大而长微弦也。浮为虚，
革为寒，寒虚相搏，则肠鸣，与当归四逆汤，补虚散寒。
脉象濡软而细弱，细弱的脉象反而出现在关部，濡软的脉象反而出现在寸部（巅）；微弱的脉象出现在上部，涩滞的脉象出现在下部。脉微弱说明阳气不足，脉涩说明阴血亏虚。如果阳气本已微弱，又患中风病，出现汗出且反而烦躁不安；脉涩说明无血，会导致四肢厥冷并且畏寒。阳气微弱不可使用攻下法，如果误用攻下法，会导致胃脘部痞塞胀硬。
阳气微弱而误用攻下，导致阳气更加虚弱，阴气在体内盛极，所以出现胃脘部痞塞胀硬的症状。
腹部脐周有搏动感位于右侧，不可使用攻下法。如果误用攻下法，会导致体内津液枯竭，出现咽喉干燥、鼻孔干燥、头晕目眩、心悸等症状。
腹部脐周搏动感位于右侧，是肝脏功能异常的表现。攻下法会损伤胃气并扰动肺气，导致津液内竭。咽喉干燥、鼻孔干燥，是因为肺属金，主燥；头晕目眩、心悸，是因为肺主气，肺气虚弱所致。
腹部脐周有搏动感位于左侧，不可使用攻下法。如果误用攻下法，会导致腹内拘急挛缩，饮食难进，脐周搏动感更加剧烈。即使身体发热，患者也只想蜷卧。
腹部脐周搏动感位于左侧，是肝气异常的表现。攻下法会损伤脾气，导致肝气更加亢盛，进而乘犯脾土，所以出现腹内拘急、饮食不下、脐周搏动加剧的症状。即使身体发热，但因为里气不足，所以睡觉时喜欢蜷缩。
腹部脐周有搏动感位于上方，不可使用攻下法。如果误用攻下法，会导致手掌心发热烦闷，身上皮肤浮肿发冷，热汗自出，想要用水浇淋身体。
腹部脐周搏动感位于上方，是心气异常的表现。攻下法会损伤胃气，进而扰动心气。心属火，主热，《针经》说：“心所生的疾病，表现为掌心发热。”肝为脏中之阴，患病时虽有身热，但睡觉时喜欢蜷缩，这是表热里寒的表现；心为脏中之阳，患病时身上浮肿发冷，热汗自出，想要用水浇淋，这是表寒里热的表现。这两脏的阴阳寒热属性，可以清楚地看出来。
腹部脐周有搏动感位于下方，不可使用攻下法。如果误用攻下法，会导致腹胀满，突然起身时头晕目眩，进食后排出未消化的食物（完谷不化），胃脘部痞塞。
腹部脐周搏动感位于下方，是肾气异常的表现。攻下法会损伤脾气，导致肾气动摇，肾中寒气乘袭脾土，所以出现腹胀满、头晕目眩、完谷不化、胃脘痞塞的症状。
咽喉部闭塞不通，不可使用攻下法。如果误用攻下法，会导致上部轻浮下部沉重，水浆无法咽下，睡觉时喜欢蜷缩，身体拘急疼痛，腹泻每天几十次。
咽喉部闭塞，说明胃气已经不和。攻下法使闭塞之邪在上部显得轻浮，同时进一步损伤胃气导致下部沉重，直到水浆不下，睡觉蜷缩，身体拘急疼痛，腹泻每日数十次，可知这是虚寒证。
所有外实证的病，不可使用攻下法。如果误用攻下法，会引发轻微发热，脉搏消失、四肢厥冷的患者，肚脐周围会有握持般的灼热感。
外实证是指表热证，应当使用发汗法治疗才能痊愈，使用攻下法是逆治。攻下后导致里虚，表热内陷，所以引发轻微发热。厥逆越深重，内热也越深重，脉搏消失、四肢厥冷的患者，是因为阳气深陷，客居于下焦，所以肚脐周围感到灼热。
所有虚证，不可使用攻下法。如果误用攻下法，会导致极度口渴，想喝水的患者容易治愈；厌恶喝水的患者病情加重。
《金匮玉函》说：“虚证应当十次补益，不要一次泻下。”虚人误用攻下法属于双重虚损，导致内部津液枯竭，所以引起极度口渴。想喝水的人，说明阳气尚未枯竭，还可以治愈；厌恶喝水的人，说明阳气已经枯竭，则难以控制。
脉象濡软而细弱，细弱的脉象反而出现在关部，濡软的脉象反而出现在寸部；弦紧的脉象反而出现在上部，微弱的脉象反而出现在下部。弦脉代表阳气运行，微脉代表阴寒。上实下虚，意念中希望得到温补。
虚人误用攻下法称为双重虚损。《难经》说：“实证更实，虚证更虚，损害不足的，增加有余的。”这是中等水平的医生造成的危害。
脉微弱则会咳嗽，咳嗽则吐出涎沫，如果误用攻下法，虽然咳嗽停止，但腹泻不会停止。
腹泻不停止，则胸中感觉像虫子咬一样难受，喝粥就会吐出来，小便不利，两胁拘急，呼吸喘促困难，颈背相互牵引，手臂麻木不仁，极度寒冷反而出汗，身体冰冷如冰，眼睛昏暗不明，胡言乱语不止，虽然谷物大量进入，这叫做“除中”（胃气将绝的假象），口中虽然想说话，但舌头不能前伸。
《内经》说：“感受寒邪，就会生病。轻微则咳嗽，严重则腹泻、疼痛。”肺感受轻微寒邪导致咳嗽，脉象也会微弱。误用攻下法，气机下陷咳嗽虽止，但因腹泻不止，腹泻不止则耗夺正气，形成危重恶候。胸中如虫咬，喝粥即吐，小便不利，两胁拘急，呼吸喘促困难，是里气受损。颈背相互牵引，手臂麻木，极度寒冷反而出汗，身体冰冷如冰，是表气受损。表里之气受损至极，导致阴阳俱脱，眼睛昏暗不明，胡言乱语。《难经》说：“阳气脱失的人会看见鬼，阴气脱失的人会失明。”阴阳脱失的人，应该不能进食，但谷物却大量进入，这叫做“除中”，是胃气离去的表现，口中虽然想说话，但舌头不能前伸，是因为气已衰败脱失，无法运化。
脉象濡软而细弱，细弱的脉象反而出现在关部，濡软的脉象反而出现在寸部；浮脉反而出现在上部，数脉反而出现在下部。浮脉代表阳虚，数脉代表无血（医统本作“亡血”），浮脉代表虚，数脉（赵本作“生”）代表热。浮脉代表虚，自汗出且恶寒；数脉代表痛，战栗发冷且（赵本作“而寒”）颤抖。微弱脉出现在关部，胸下紧迫，喘息汗出且呼吸困难，呼吸时胁肋疼痛，战栗与寒冷相搏，症状像疟疾一样，医生反而误用攻下法，所以导致脉数、发热、狂跑见鬼，胃脘痞塞，小便淋漓不尽，（赵本作“漓”）小腹非常硬，小便尿血。
细弱脉在关部，说明阴气内部虚弱；濡软脉在寸部，说明阳气外部虚弱。浮脉代表虚，浮脉在上，说明卫气不足，所以说阳虚。阳虚不固，所以腠理开泄汗出、恶寒；数脉也代表虚，数脉在下说明营血不及，所以说亡血。亡血则不能温润脏腑，脉数且痛，战栗发冷。微弱脉在关部，说明邪气传入里部，里虚遇到邪气，胸下紧迫，喘息汗出，胁下牵引疼痛，战栗如疟。此时里邪未实，表邪未解，医生反而误用攻下法，导致里气更加虚弱，邪热内陷，所以脉数、发热、狂跑见鬼，胃脘痞塞，这是热邪陷入中焦。如果热气深陷，则客居于下焦，导致小便淋漓，小腹非常硬，小便尿血。
脉象濡软而紧，濡软说明卫气微弱，紧脉说明营分有寒。阳气微弱、卫分中风，发热且恶寒；营分紧、胃气冷，轻微呕吐且心中烦闷。医生认为有大热，使用解肌发汗法。导致亡阳、虚性烦躁，胃脘部苦于痞塞坚硬。表里俱虚竭，突然起身时头晕目眩。客热停留在皮肤，惆怅郁闷不得睡眠。不知道胃气寒冷，紧寒在关元穴处。医术高超者也无从施展，汲水浇灌身体。客热暂时消退，战栗发冷。盖上厚被子覆盖，汗出且头部昏冒。身体惊恐震颤，小便轻微困难。寒气因水而发作，完谷不化的腹泻不容间断。呕吐变为肠管脱出，颠倒不安不得安宁。手足轻微逆冷，身体冰冷而内心烦乱。迟来的补救，怎么能够追回呢？
胃冷营寒，阳气微弱中风，发热恶寒，轻微呕吐心烦。医生不温胃，反而认为是热证，解肌发汗，导致表虚亡阳，烦躁，胃脘痞塞坚硬。先有里虚，发汗又使表虚，表里俱虚竭，突然起身头晕。客热在表，惆怅不得眠。医生不救里，只责备表热，汲水灌洗以退热，客热易退，里寒更增，战栗发冷。再用厚被覆盖，表虚遂汗出，更加使阳气虚弱。
巅，指头顶。头昏冒且身体振颤发冷，（医统本作“顶冒颠体振寒”）小便困难，是亡阳的表现。寒气因水而发作，下利完谷，上为呕吐，外有厥逆，内有躁烦，颠倒不安，虽然想拯救也无法挽回。《本草》说：“病势已过，生命将难保全。”
脉象浮大，浮脉代表气实，大脉代表血虚。血虚即为无阴，孤阳独自下行至阴部，小便应赤涩困难，胞宫当虚，现在反而小便通利，且大汗出，按理说卫气应当微弱，现在反而更实，津液四散流失，营血枯竭，干烦不得睡眠，血液稀薄肌肉消瘦，而成暴（赵本注：“一云黑”）液。医生再用毒药攻伐胃气，这是双重虚损，客居的阳气离去有期，必然下利如污泥而死。
卫为阳，营为阴。卫气强实，阴血虚弱，阳乘阴虚，下行至阴部。阴部，指下焦。阳为热则消耗津液，应当小便赤涩困难；现在反而小便通利且大汗出，是阴气内部虚弱。经文说：“阴弱者，汗自出。”因此卫气不微弱反而更实，营竭血尽，干烦不眠，血薄则肉消，而成暴液的，是津液四散流失。医生反而攻下，又使里虚，这是双重虚损，孤阳因攻下而脱去，气血皆竭，胃气在内耗尽，必然下利如污泥而死。
脉数，久数不止，若停止则邪气结聚，正气不能恢复，正气退却结于脏腑，所以邪气浮越，与皮毛相合。脉数的病，不可攻下，攻下则（赵本无“则”字）必定烦躁且腹泻不止。
数为热，停止则邪气结于经络之间，正气不能（医统本作“得”）复行于表，则退却结于脏，邪气独浮于皮毛。攻下使里虚，邪热乘虚而入，里虚协热，必定烦躁且腹泻不止。
脉浮大，应当发汗，医生反而攻下，这是大逆。（赵本有“也”字）
浮大属表，所以不可攻下。病欲呕吐的，不可攻下。
呕吐多，即使有阳明证，也不可攻下。
因为邪气还在胸中。
太阳病，（赵本有“有”字）外证未解，不可攻下，攻下为逆。
表证未解，即使有里证也不可攻下，应当先解表为顺；如果反而攻下，则为逆。经文说：“本应发汗反而攻下，此为逆。如果先发汗，治疗不为逆。”
凡是阳热多的病，攻下则大便硬结。
阳热证多，则津液少，攻下虽除热，又损伤津液，必定大便困难。有人说阳多者是表热，攻下则胃脘硬。
无阳阴强，大便硬的，攻下则（赵本无“则”字）必定完谷不化且腹胀满。
无阳，指亡失津液；阴强，指寒多。大便硬则是阴结，攻下使胃虚，阴寒内盛，必定完谷不化且腹胀满。
伤寒发热，头痛，微汗出。发汗，则神志不清不认识人；用火熏法则气喘，小便不通，心腹满；攻下则短气，小便难，头痛，背强；加用温针则鼻出血。
伤寒通常无汗，发热头痛，微汗出的，是寒邪变热，欲传于里。发汗则亡阳，憎热，所以不认识人；如果用火熏，则火热伤气，内部消烁津液，结为里实，所以气喘，小便不通，心腹满；如果反而攻下，则内虚津液，邪欲入里，外动经络，所以短气，小便难，头痛，背强；如果加用温针，益阳增热，必定动血而为衄血。
伤寒，脉阴阳俱紧，恶寒发热，则脉象欲厥。厥者，脉初来大，渐渐小，再来渐渐大，（赵本下无“渐”字）是其征候。像这样的恶寒，严重的，翕翕汗出，喉咙痛；（赵本有“若”字）热多的，眼睛红脉多，眼睛昏暗，医生再发汗，咽喉则受伤；如果再攻下，则两眼闭合，寒多的（赵本无“者”字）则完谷不化，热多的（赵本无“者”字）则便脓血；如果熏蒸，则身体发黄；如果熨烫，则咽喉干燥。如果小便通利的，可救；（赵本有“若”字）小便困难的，为危殆。
脉阴阳俱紧，清邪中于上部，浊邪中于下部，太阳少阴都感受了邪气。恶寒的是少阴，发热的是太阳，脉欲厥是表邪欲传里。恶寒严重的，则变热，翕翕汗出，喉咙痛，因为少阴经脉循行喉咙的缘故。热多的，太阳多；眼睛红脉多，眼睛昏暗，因为太阳经脉起于目的缘故。发汗攻阳，则少阴的热因发汗而上行，所以咽喉受伤。如果再攻下，则太阳的邪气，因虚而内陷，所以两眼闭合。阴邪下行为寒多，必完谷不化；阳邪下行为热多，必便脓血。熏蒸，则火热甚，身体必发黄。熨烫，则火热轻，必为咽喉干燥。小便通利的，为津液未竭，还可救；小便困难的，津液已绝，则难控制而危殆。
伤寒发热，口中勃勃热气出，头痛，目黄，鼻出血不可制止，贪水的必呕吐，恶水的必厥逆。如果攻下，咽喉生疮，假如手足温的，必下重便脓血。头痛目黄的，如果攻下，则（赵本无“两”字）两眼闭合。贪水的，（赵本有“若下之其”四字）脉必厥，声音低微，咽喉堵塞；如果发汗，则战栗，阴阳俱虚。恶水的，如果攻下，则里冷不嗜食，大便完谷而出；如果发汗，则口中受伤，舌上白苔，烦躁，（赵本医统本并作“躁”）脉数实，不大便，六七日 后，必便血；如果发汗，则小便自利。
伤寒发热，是寒变热。口中勃勃气出，是热客于上膈。头痛目黄，鼻出血不可制的，是热蒸于上。《千金》说：“无阳即厥，无阴即呕。”贪水的必呕，则阴虚；恶水的厥，则阳虚。发热口中勃勃气出，咽中已热，如果攻下亡津液，则咽喉生疮，热因里虚而下，如果热气内结，则手足必厥。假设手足温的，热气不结而下行，作协热利，下重便脓血。头痛目黄的，攻下，热气内伏，则目闭。贪水为阴虚，攻下又虚其里，阳气内陷，故脉厥声嘤，咽喉闭塞。阴虚发汗，又虚其阳，使阴阳俱虚而战栗。恶水为阳虚，攻下又虚胃气，虚寒内甚，故里冷不嗜食。阳虚发汗，则上焦虚燥，故口中伤烂，舌上白苔而烦躁（医统本作“躁”）。经文说：“脉数不解，合热则消谷喜饥。”到了六七天不大便的，此有瘀血，此脉数实，不大便六七日，热蓄血于内。七日之后，邪热渐解，迫血下行，必便血。便血发汗，阴阳俱虚，故小便利。
下利，脉大的，是虚证，因为强行攻下的缘故。如果脉浮革，确实肠鸣的，属于当归四逆汤主治。（赵本无“主之”二字，有“当归四逆汤方”详见卷六）
脉大为虚，因为不应下而攻下，腹泻因而不停。浮脉，按之不足；革脉，实大而长微弦。浮为虚，革为寒，寒虚相搏，则肠鸣，给予当归四逆汤，补虚散寒。
The pulse is soft and weak (Ru Ruo); the weak pulse appears at the Guan position, while the soft pulse appears at the Cun position (Dian). The faint pulse (Wei) appears in the upper part, and the choppy pulse (Se) appears in the lower part. A faint pulse indicates insufficiency of Yang Qi; a choppy pulse indicates absence of Blood. If Yang Qi is already faint, and Wind-Strike occurs with sweating followed by restlessness; if the pulse is choppy indicating Blood deficiency, it leads to Cold limbs (Jue) and coldness. When Yang Qi is faint, purgation must not be used; if mistakenly purged, epigastric fullness and hardness (Xin Xia Pi Ying) will result.
If Yang Qi is faint and purgation is used, Yang Qi becomes deficient and Yin Qi becomes excessive internally, causing epigastric fullness and hardness.
If pulsation is felt on the right side of the umbilicus, purgation must not be used. Mistaken purgation depletes internal fluids, leading to dry throat, dry nose, dizziness, and palpitations.
Pulsation on the right indicates Liver disturbance. Purgation damages Stomach Qi and disturbs Lung Qi, depleting fluids. Dry throat and nose occur because the Lung belongs to Metal and governs dryness; dizziness and palpitations occur because the Lung governs Qi and is deficient.
If pulsation is felt on the left side of the umbilicus, purgation must not be used. Mistaken purgation causes abdominal cramping, inability to eat, and intensified pulsation. Even if there is body heat, the patient desires to curl up.
Pulsation on the left indicates Liver Qi disturbance. Purgation damages Spleen Qi, allowing Liver Qi to become excessive and invade the Spleen, causing abdominal cramping, food intolerance, and intensified pulsation. Although there is body heat, due to insufficient interior Qi, the patient curls up when lying down.
If pulsation is felt above the umbilicus, purgation must not be used. Mistaken purgation causes heat and vexation in the palms, floating coldness on the body, spontaneous hot sweating, and a desire to pour water over oneself.
Pulsation above indicates Heart Qi disturbance. Purgation damages Stomach Qi and disturbs Heart Qi. The Heart belongs to Fire and governs heat; as stated in the *Zhen Jing*: "Diseases generated by the Heart manifest as heat in the palm." The Liver is Yin among the Zang organs; when diseased, despite body heat, the patient curls up, representing exterior heat and interior cold. The Heart is Yang among the Zang organs; when diseased, it presents with floating coldness, hot sweating, and desire for water pouring, representing exterior cold and interior heat. The Yin-Yang and cold-heat distinctions of these two organs are clearly visible.
If pulsation is felt below the umbilicus, purgation must not be used. Mistaken purgation causes abdominal fullness, dizziness upon sudden rising, passage of undigested food (Qing Gu), and epigastric fullness.
Pulsation below indicates Kidney Qi disturbance. Purgation damages the Spleen, causing Kidney Qi to move; Kidney Cold attacks the Spleen, resulting in abdominal fullness, dizziness, Qing Gu, and epigastric fullness.
If the throat feels obstructed, purgation must not be used. Mistaken purgation results in lightness above and heaviness below, inability to swallow liquids, desire to curl up, body stiffness and pain, and diarrhea dozens of times a day.
Throat obstruction indicates Stomach disharmony. Purgation makes the obstructing pathogen light above and further damages Stomach Qi causing heaviness below, leading to inability to swallow, curling up, body pain, and severe diarrhea, indicating deficiency-cold.
For all exterior excess conditions, purgation must not be used. Mistaken purgation induces slight fever; in cases where the pulse disappears and limbs are cold (Wang Mai Jue), there is burning heat around the umbilicus.
Exterior excess refers to exterior heat; diaphoresis cures it, while purgation is contraindicated. Purgation causes interior deficiency, allowing exterior heat to sink inward, inducing slight fever. The deeper the Jue, the deeper the heat; in Wang Mai Jue, Yang Qi sinks deeply into the Lower Jiao, causing heat around the umbilicus.
For all deficiency conditions, purgation must not be used. Mistaken purgation causes extreme thirst. Those seeking water may recover; those rejecting water worsen.
The *Jin Gui Yu Han* states: "For deficiency, tonify ten times; do not purge once." Purging the deficient constitutes double deficiency, depleting fluids and causing extreme thirst. Those seeking water have unexhausted Yang Qi and can recover; those rejecting water have exhausted Yang Qi and are difficult to treat.
The pulse is soft and weak; weak at Guan, soft at Cun. String-taut (Xian) appears above, faint (Wei) appears below. Xian indicates Yang movement; Wei indicates Yin cold. Excess above and deficiency below indicate a desire for warmth. Faint and string-taut together indicate deficiency; deficiency must not be purged.
Purging the deficient creates double deficiency. The *Nan Jing* states: "Making excess more excess and deficiency more deficiency harms the insufficient and benefits the surplus." This is the harm caused by average physicians.
A faint pulse causes coughing and salivation. If purged, cough stops but diarrhea persists. Persistent diarrhea causes chest discomfort like insect bites, regurgitation of congee, difficulty urinating, hypochondriac cramping, difficult breathing, neck-back traction, arm numbness, extreme cold with sweating, icy body, dull eyes, incessant speech, and excessive food intake. This is called Chu Zhong (Elimination of the Middle), where the mouth wants to speak but the tongue cannot advance.
The *Nei Jing* states: "Cold invasion causes disease. Mildly it causes cough; severely it causes diarrhea or pain." Lung cold causes cough and faint pulse. Purgation lowers Qi, stopping cough but causing persistent diarrhea, draining righteous Qi and creating critical danger. Chest discomfort, regurgitation, urinary difficulty, hypochondriac cramping, and breathing difficulty indicate interior Qi damage. Neck-back traction, arm numbness, extreme cold with sweating, and icy body indicate exterior Qi damage. Extreme exterior-interior damage leads to Yin-Yang collapse. Dull eyes and incessant speech occur. The *Nan Jing* states: "Yang collapse sees ghosts; Yin collapse causes blindness." Those with Yin-Yang collapse should not eat, yet eat excessively; this is Chu Zhong, indicating stomach Qi departure. Mouth wanting to speak but tongue unable to advance shows Qi exhaustion and failure to transform.
The pulse is soft and weak; weak at Guan, soft at Cun. Floating (Fu) appears above, rapid (Shu) appears below. Fu indicates Yang deficiency; Shu indicates blood loss (Wang Xue). Fu indicates deficiency; Shu indicates heat. Fu deficiency causes spontaneous sweating and aversion to cold; Shu indicates pain, chills, and trembling. Weakness at Guan causes chest urgency, panting, sweating, and respiratory distress, with rib pain during breathing, chills resembling malaria. If mistakenly purged, it causes rapid pulse, fever, manic running, seeing ghosts, epigastric fullness, dribbling urination, hard lower abdomen, and hematuria.
Weakness at Guan indicates interior Yin deficiency; softness at Cun indicates exterior Yang deficiency. Fu above indicates Wei Qi insufficiency (Yang deficiency). Yang deficiency fails to secure, causing sweating and aversion to cold. Shu below indicates Ying Blood insufficiency (Blood loss). Blood loss fails to moisten organs, causing painful rapid pulse and chills. Weakness at Guan indicates pathogen entering the interior. Interior deficiency meeting pathogen causes chest urgency, panting, sweating, rib pain, and chills. With interior pathogen not solid and exterior pathogen unresolved, mistaken purgation increases interior deficiency and allows heat to sink inward, causing rapid pulse, fever, mania, and epigastric fullness (heat sinking to Middle Jiao). If heat sinks deeply to Lower Jiao, it causes dribbling urination, hard lower abdomen, and hematuria.
The pulse is soft and tight. Soft indicates Wei Qi weakness; tight indicates Cold in Ying. Yang weakness and Wei Wind-Strike cause fever and aversion to cold. Ying tightness and Stomach Cold cause mild vomiting and inner vexation. If the physician mistakes this for high heat and uses diaphoresis, it causes Yang collapse, deficiency vexation, and hard epigastric fullness. Exterior and interior become exhausted, causing dizziness upon rising. Guest heat on skin causes insomnia. Ignoring Stomach Cold and Guan Yuan Cold, even skilled physicians fail. Pouring water on the body temporarily removes guest heat but causes shivering. Covering with heavy blankets causes head dizziness from sweating. Body tremors and difficult urination follow. Cold triggered by water causes continuous Qing Gu diarrhea. Vomiting turns into intestinal prolapse. Restlessness ensues. Hand-foot mild inversion, cold body, and inner vexation occur. Late rescue cannot restore life.
Stomach cold and Ying cold, Yang weakness with Wind-Strike, fever, aversion to cold, mild vomiting, and vexation. The physician fails to warm the Stomach, mistaking it for heat, and uses diaphoresis, causing exterior deficiency, Yang collapse, vexation, and hard epigastric fullness. Pre-existing interior deficiency plus diaphoresis exhausts both exterior and interior, causing dizziness. Guest heat on exterior causes insomnia. Physician ignores interior, treating only exterior heat with water washing. Guest heat fades, but interior cold increases, causing shivering. Heavy blankets cause sweating, further weakening Yang. Head dizziness and tremors with difficult urination indicate Yang collapse. Cold triggered by water causes upper vomiting and lower Qing Gu. Exterior Jue and interior vexation lead to irrecoverable restlessness. The *Ben Cao* states: "When disease progress passes, life is hard to save."
Pulse floating and large. Floating indicates Qi excess; large indicates Blood deficiency. Blood deficiency means no Yin. Solitary Yang descends to Yin parts, causing red, difficult urination and empty uterus. Now, urination is free and sweating is profuse. Wei Qi should be weak but is actually strong, fluids scatter, Ying exhausts, Blood ends, causing dry vexation, insomnia, thin blood, muscle wasting, and violent fluid discharge. If physician uses toxic drugs to attack the Stomach, it is double deficiency. Guest Yang departs soon; death comes with stool like mud.
Wei is Yang, Ying is Yin. Strong Wei Qi and weak Yin Blood allow Yang to invade Yin parts (Lower Jiao). Heat consumes fluids, causing red difficult urination. Now free urination and profuse sweating indicate weak interior Yin. Scripture says: "Yin weakness causes spontaneous sweating." Thus Wei is not weak but strong. Ying exhaustion causes dry vexation, insomnia, muscle wasting, and fluid scattering. Mistaken purgation causes double deficiency. Solitary Yang collapses after purgation. Qi and Blood exhaust, Stomach Qi ends inside; death comes with stool like mud.
Rapid pulse lasting long without stopping indicates pathogen binding; righteous Qi cannot recover and retreats to Zang, leaving pathogen floating on skin-hair. Rapid pulse must not be purged; purgation causes vexation and persistent diarrhea.
Rapid indicates heat. Stopping indicates pathogen binding in collaterals; righteous Qi cannot return to exterior, retreating to Zang, leaving pathogen on skin. Purgation empties interior; heat enters deficiency, causing vexation and diarrhea.
Floating-large pulse requires diaphoresis; mistaken purgation is major reversal. Floating-large belongs to exterior, so purgation is forbidden. Disease desiring vomiting must not be purged.
Frequent vomiting, even with Yangming syndrome, must not be attacked with purgation. Because pathogen is still in the chest.
Taiyang disease with unresolved exterior signs must not be purged; purgation is reversal. If exterior is unresolved, even with interior signs, do not purge; resolve exterior first. Reversal occurs if purged. Scripture: "Should have sweated but purged is reversal; should have purged but sweated is not reversal" (Note: Text implies resolving exterior first is correct).
Diseases with much Yang-heat become hard if purged. Yang-heat excess means less fluids; purgation removes heat but damages fluids, causing constipation. Some say Yang excess is exterior heat; purgation causes epigastric hardness.
No Yang, Yin strength, hard stool: purgation causes Qing Gu and abdominal fullness. No Yang means fluid loss; Yin strength means much cold. Hard stool is Yin binding; purgation empties Stomach, increasing interior cold, causing Qing Gu and fullness.
Shanghan with fever, headache, slight sweating. Diaphoresis causes delirium. Moxibustion/fumigation causes asthma, urinary retention, heart-abdominal fullness. Purgation causes shortness of breath, difficult urination, headache, stiff back. Warm needle causes epistaxis.
Shanghan usually has no sweat. Fever, headache, slight sweating indicates cold transforming to heat, transmitting inward. Diaphoresis causes Yang collapse and heat aversion/delirium. Fumigation damages Qi, consumes fluids, creates interior excess, causing asthma, urinary retention, fullness. Purgation empties interior, draws pathogen inward, moves collaterals externally, causing shortness of breath, difficult urination, headache, back stiffness. Warm needle increases Yang-heat, moving blood to cause epistaxis.
Shanghan with Yin-Yang tight pulse, aversion to cold, fever, pulse欲 Jue. Jue means pulse starts large, gets small, then large again. Severe cold causes slight sweating and sore throat. Heat-dominant causes red eyes, many pulses, dull vision. Further diaphoresis injures throat. Further purgation closes eyes. Cold-dominant causes Qing Gu; heat-dominant causes pus-blood stool. Fumigation causes jaundice. Cupping causes dry throat. Free urination is salvageable; difficult urination is critical.
Tight Yin-Yang pulse: clear pathogen attacks upper, turbid pathogen attacks lower; Taiyang and Shaoyin both affected. Aversion to cold is Shaoyin; fever is Taiyang. Pulse欲 Jue means exterior pathogen transmitting inward. Severe cold transforms to heat, slight sweating, sore throat (Shaoyin channel passes throat). Heat-dominant is Taiyang; red eyes, dull vision (Taiyang channel starts at eye). Diaphoresis attacking Yang sends Shaoyin heat upward, injuring throat. Purgation allows Taiyang pathogen to sink inward due to deficiency, closing eyes. Yin pathogen descending is cold-dominant (Qing Gu); Yang pathogen descending is heat-dominant (pus-blood stool). Fumigation causes severe fire and jaundice. Cupping causes mild fire and dry throat. Free urination means fluids intact (salvageable); difficult urination means fluids exhausted (critical).
Shanghan fever, bubbling breath from mouth, headache, yellow eyes, uncontrollable epistaxis. Thirsty patients vomit; water-rejecting patients have Jue. Purgation causes throat ulcers. If hands/feet warm, lower heaviness and pus-blood stool. Headache/yellow eyes: purgation closes eyes. Thirsty: pulse Jue, low voice, throat block. Diaphoresis causes chills, Yin-Yang deficiency. Water-rejecting: purgation causes interior cold, anorexia, Qing Gu. Diaphoresis causes mouth injury, white tongue coating, vexation, rapid-solid pulse, constipation; after 6-7 days, bloody stool. Diaphoresis causes free urination.
Shanghan fever is cold transforming to heat. Bubbling breath is heat in Upper Jiao. Headache, yellow eyes, uncontrollable epistaxis is heat steaming upward. *Qian Jin*: "No Yang is Jue; no Yin is vomiting." Thirsty vomiting is Yin deficiency; water-rejecting Jue is Yang deficiency. Hot throat from fever/breath: purgation loses fluids, causing throat ulcers. Heat sinking due to interior deficiency: if heat binds, hands/feet Jue. If hands/feet warm, heat descends without binding, causing協熱利 (collateral heat diarrhea) with lower heaviness and pus-blood. Headache/yellow eyes: purgation traps heat, closing eyes. Thirst is Yin deficiency; purgation empties interior, sinking Yang, causing pulse Jue, low voice, throat block. Yin deficiency + diaphoresis empties Yang, causing chills. Water-rejecting is Yang deficiency; purgation empties Stomach, increasing cold, causing interior cold/anorexia. Yang deficiency + diaphoresis empties Upper Jiao, causing mouth injury, white coating, vexation. Scripture: "Rapid pulse unresolved, combined heat digests food and causes hunger." Constipation after 6-7 days indicates blood stasis. Rapid-solid pulse, constipation 6-7 days, heat storing blood internally. After 7 days, heat resolves, forcing blood downward, causing bloody stool. Bloody stool + diaphoresis = Yin-Yang deficiency, hence free urination.
Diarrhea with large pulse is deficiency, caused by forced purgation. If pulse is floating-leather (Ge) with borborygmus, use Danggui Sini Tang.
Large pulse indicates deficiency due to improper purgation causing persistent diarrhea. Floating means pressure yields little; Leather means solid, large, long, slightly string-taut. Floating is deficiency; Leather is cold. Cold-deficiency interaction causes borborygmus. Give Danggui Sini Tang to tonify deficiency and disperse cold.